Colonoscopy and OGD Infection Risk Higher Than Expected

Colonoscopies and osophagogastroduodenoscopies (OGDs) performed at outpatient specialty centers result in far more infections than previously believed, according to a new study.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) conducted a study to estimate the rates of infections following colonoscopy and OGD procedures performed during 2014 in ambulatory surgery centers (ASCs) in the states of California, Florida, Georgia, Nebraska, New York, and Vermont. The researchers identified infection-related emergency department (ED) visits and in-patient admissions within 7 and 30 days of the screening procedure, noted infection sites and organisms, and analyzed predictors of infections. Screening mammography, prostate cancer screening, bronchoscopy, and cystoscopy procedures were comparators.

The results revealed post-endoscopic infection rates of 1.1 per 1,000 for screening colonoscopy, 1.6 for non-screening colonoscopy, and 3 for OGD procedures; all higher than screening mammography (0.6), but lower than bronchoscopy (15.6) and cystoscopy (4.4). The rates of 7-day post-endoscopic infections varied widely by ASC, ranging from 0-115 per 1,000 procedures for screening colonoscopy, 0-132 for non-screening colonoscopy and 0-62 for OGD. Predictors included recent history of hospitalization or endoscopic procedure; low procedure volume or non-freestanding ASC; younger or older age; black or Native American race, and male sex. The study was published in the May 2018 issue of Gut.

“Patients who had been hospitalized before undergoing one of the procedures were at even greater risk of infection,” said senior author Susan Hutfless, MD, of the division of gastroenterology and hepatology. “Since many ASCs lack an electronic medical record system connected to hospital EDs, those ASCs are unlikely to learn of their patients' infections. If they don't know their patients are developing these serious infections, they're not motivated to improve their infection control.”

More than 15 million colonoscopies and seven million EGDs are performed annually in the United States alone; both procedures are performed with reusable endoscopes. Inadequate reprocessing between patients can result in retention of blood, tissue, and other biological debris, which can allow microbes to survive the disinfection or sterilization process. Inadequate reprocessing can also result in other adverse patient outcomes, such as tissue irritation from residual chemical disinfectants.

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